Emergency Medicine Journal最新文献

{"title":"Diversity of CPR manikins for basic life support education: use of manikin sex, race and body shape - a scoping review.","authors":"Christoph Veigl, Benedikt Schnaubelt, Sabine Heider, Andrea Kornfehl, Simon Orlob, Enrico Baldi, Erwin Snijders, Natalie Elizabeth Anderson, Sabine Nabecker, Joachim Schlieber, Zehra' Al-Hilali, Mahmoud Tageldin Mustafa, Mario Krammel, Federico Semeraro, Robert Greif, Sebastian Schnaubelt","doi":"10.1136/emermed-2024-214778","DOIUrl":"https://doi.org/10.1136/emermed-2024-214778","url":null,"abstract":"<p><strong>Background: </strong>Cardiopulmonary resuscitation (CPR) manikins typically appear white, lean and male. However, internationally, this does not represent the overall population or those who are at greatest risk of cardiac arrest. Diverse demographic groups including people of colour, women and obese people are known to be less likely to receive bystander CPR, public access defibrillation and suffer less favourable outcomes. It is plausible that failure to represent women, racially diverse and non-lean manikins can contribute to poor clinical outcomes in these populations. The aim of this scoping review was to summarise the current evidence for adaptations of manikins used for layperson Basic Life Support (BLS) training.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, PsycINFO, CINAHL, ERIC, Web of Science, Infromit, Scopus and Cochrane Central Register of Controlled Trials to identify all empirical studies describing or evaluating CPR manikin diversity. Data on participant characteristics, manikin adaptations, study design, and key findings of included studies describing or evaluating CPR manikin diversity were extracted.</p><p><strong>Results: </strong>Initially, 2719 studies were identified, and 15 studies were finally included and were grouped into (1) studies analysing adaptions of 'standard' manikins used in training (n=11) and (2) studies evaluating CPR manikin diversity used for online learning and on social media (n=4). Six of the studies analysing different adaptations reported the influence of the manikins' sex on comfort in performing CPR, quality of chest compression, automated external defibrillator use and removing clothes; four the effects of obese manikins; and one an ethnically diverse manikin. Seven of the studies used do-it-yourself adaptions. Racial and gender diversity of CPR manikins found in educational videos was limited, with only 5% of educational videos featuring non-white manikins and 1% featuring female manikins.</p><p><strong>Conclusion: </strong>Adaptations of manikins used for BLS CPR training for laypersons still do not represent the diversity of communities most people are living in, internationally. There are hints that using diverse racial manikins has the potential to improve engagement in CPR training. Reported barriers hindering the use of adapted manikins were high costs and availability of these manikins.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/emermed-2025-215161","DOIUrl":"https://doi.org/10.1136/emermed-2025-215161","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary embolism diagnosis and the D-dilemma.","authors":"Daniel Horner, Lara N Roberts","doi":"10.1136/emermed-2025-215058","DOIUrl":"https://doi.org/10.1136/emermed-2025-215058","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjust-Unlikely pulmonary embolism testing using telephone recruitment: a pilot study to assess the feasibility of evaluating its safety and efficiency.","authors":"Nicole F Morris, Rasha Georgie, Christine L D'Arsigny, Paula James, Sameer Parpia, Federico Germini, Natasha Clayton, David Good, Kerstin de Wit","doi":"10.1136/emermed-2024-214465","DOIUrl":"https://doi.org/10.1136/emermed-2024-214465","url":null,"abstract":"<p><strong>Background: </strong>Studies on pulmonary embolism (PE) rule-out strategies traditionally recruited patients in the ED. This method is increasingly impractical given excessive pressures experienced in EDs. Attempting to reach patients after leaving the ED may be more feasible. The aim of this study was to assess the feasibility of recruiting and following patients for an ED PE testing study by telephone.</p><p><strong>Methods: </strong>This was a prospective pilot study conducted in one ED and one urgent care centre in Ontario, Canada. Adult patients tested for PE using Adjust-Unlikely (a simple decision rule combining Gestalt with age-adjusted D-dimer) were called for consent after leaving the ED. Patients were followed for 90 days by medical record review plus telephone, text or email to identify subsequent venous thromboembolism testing. Venous thromboembolism events were independently adjudicated. Feasibility outcomes were recruitment rate, missed eligible rate and follow-up rate. Progression criteria were a recruitment rate of at least five participants per site, per week, a missed eligible rate of no more than two patients per site, per week, and a follow-up rate of at least 90% of enrolled patients.</p><p><strong>Results: </strong>684 patients were tested for PE between 24 March and 10 June 2023. A total of 210 patients were excluded. From 474 eligible patients, 200 were recruited. Median age was 58 years, 72.2% were female, and 3.5% were diagnosed with PE on index visit. Median recruitment rate was 7 participants per site, per week (first-third quartile (Q1-Q3), 4-14) and median missed eligible rate was 6 patients per site, per week (Q1-Q3, 3-8). After 90 days, 2 participants withdrew and 191/198 (96.5%, 95% CI 92.9, 98.3%) were contacted in follow-up. 143/198 (72.2%, 95% CI 65.6, 78.0%) participants did not require pulmonary imaging because PE was excluded by Adjust-Unlikely. 1/143 (0.7%, 95% CI 0.1, 3.9%) of these participants was diagnosed with PE in the segmental pulmonary arteries during follow-up.</p><p><strong>Conclusions: </strong>Telephone recruitment did not meet predefined feasibility thresholds as the missed eligible rate was high. However, the recruitment rate was higher than in previous studies, and there was minimal loss to follow-up.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Removing systolic blood pressure from the National Early Warning Score (NEWS) for mortality prediction: an observational study.","authors":"Arian Zaboli, Francesco Brigo, Gloria Brigiari, Serena Sibilio, Marta Parodi, Norbert Pfeifer, Gianni Turcato","doi":"10.1136/emermed-2024-214291","DOIUrl":"https://doi.org/10.1136/emermed-2024-214291","url":null,"abstract":"<p><strong>Background: </strong>Vital signs in triage are essential for effective risk stratification in the emergency department (ED). They are also increasingly used to calculate an early warning score at the time of presentation. However, obtaining a blood pressure is more time-consuming than other vital signs, potentially delaying care for subsequent patients. Additionally, studies indicate that this measure is not always collected. This study aimed to evaluate whether removing systolic blood pressure (SBP) from the National Early Warning Score (NEWS) affects the prediction of mortality.</p><p><strong>Methods: </strong>This prospective observational single-centre study included all patients presenting to triage of the General Hospital of Merano, Italy, from 1 June 2022 to 30 June 2023. Vital signs were recorded for each patient. NEWS and NEWS without SBP (NEWS-SBP) were computed. The ability of the two versions of the score to predict mortality at 48 hours, 7 days and 30 days was evaluated using the Area Under the Receiver Operating Characteristic curves (AUROC).</p><p><strong>Results: </strong>Data were recorded from 26 249 patients. For predicting 7-day and 30-day mortality, NEWS had a significantly higher AUROC than NEWS-SBP (7-day mortality: 0.84, 95% CI: 0.81 to 0.87 vs 0.83, 95% CI: 0.80 to 0.86; p=0.012, and 30-day mortality: 0.79, 95% CI: 0.77 to 0.81 vs 0.77, 95% CI: 0.75 to 0.79; p<0.001). No significant difference was found in the AUROC for the prediction of 48-hour mortality (NEWS: 0.89, 95% CI: 0.85 to 0.92 vs NEWS-SBP 0.88, 95% CI: 0.85 to 0.91; p=0.139).</p><p><strong>Conclusion: </strong>The NEWS-SBP was equivalent to the complete score for prediction of 48-hour mortality, but was less accurate in predicting medium and long-term mortality among ED patients. Further research is needed to clarify potential advantages in reducing triage time and whether these benefits outweigh the loss of prognostic accuracy.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence on \"Factors associated with late hospital arrival in acute stroke patients of Bangladesh\" by Iktidar <i>et al</i>.","authors":"Wenjianbin Zhou, Shenghao Xu","doi":"10.1136/emermed-2025-214938","DOIUrl":"https://doi.org/10.1136/emermed-2025-214938","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of serious bacterial infections and performance of inflammatory markers in febrile infants with and without proven viral illness.","authors":"Zhao Xiang Choa, Gayatiri Raveentheran, Zi Xean Khoo, Gene Yong-Kwang Ong, Lena Wong, Rupini Piragasam, Sashikumar Ganapathy, Shu-Ling Chong","doi":"10.1136/emermed-2024-214435","DOIUrl":"https://doi.org/10.1136/emermed-2024-214435","url":null,"abstract":"<p><strong>Background: </strong>Febrile infants ≤90 days old with proven viral infections who may have concurrent serious bacterial infections (SBIs) remain a diagnostic dilemma. We aimed to compare the prevalence of SBIs and evaluate the performance of inflammatory markers in predicting SBIs, between infants with and without proven viral illness.</p><p><strong>Methods: </strong>We conducted a secondary analysis of febrile infants ≤90 days old presenting with temperature ≥38°C to a tertiary paediatric emergency department in Singapore between 1 December 2017 and 31 July 2022. We compared SBI prevalence, performance of white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT) and absolute neutrophil count (ANC), between infants with and without proven viral illness. We presented performance using sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>Among 1783 infants, 261 (14.6%) had SBIs, and 653 (36.6%) had proven viral infections. The prevalence of SBI was lower in infants with proven viral illness compared with those without (5.05% vs 20.2%, p<0.001, OR=0.211, 95% CI 0.144 to 0.308). In both groups, CRP >20 mg/L had the highest sensitivity (60.6%, 95% CI 42.1% to 77.1% and 67.0%, 95% CI 60.4% to 73.0% for those with proven illness and those without) and ANC >10×10⁹/L demonstrated the highest specificity (98.1%, 95% CI 96.7% to 99.1% and 93.1%, 95% CI 91.2% to 94.8%, for those with proven illness and those without), in predicting for SBIs. Using current thresholds, WBC, ANC, CRP and PCT performed with greater specificity but lower sensitivity among those with proven viral illness compared with those without. Differences in AUCs between both groups for the four inflammatory markers were only statistically significant with ANC >10×10⁹/L.</p><p><strong>Conclusions: </strong>Although febrile infants ≤90 days old with proven viral illnesses compared with those without were at lower risk of SBIs, current inflammatory markers thresholds may result in missed SBIs in this subgroup.</p><p><strong>Trial registration number: </strong>NCT04103151.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manual pressure augmentation to enhance defibrillation in cardiac arrest.","authors":"Emma Carley, Simon Carley","doi":"10.1136/emermed-2025-215019","DOIUrl":"https://doi.org/10.1136/emermed-2025-215019","url":null,"abstract":"<p><p>A shortcut review of the literature was conducted to determine whether manual pressure augmentation improves the outcome from cardiac arrest. A total of nine publications were screened by title and abstract and one study (a case report and literature review) underwent full-text review. A further review of bibliographies of relevant papers found one further relevant study protocol. Details about the author, date of publication, country of publication, patient group studied, study type, relevant outcomes (survival and return of spontaneous circulation rate), results and study limitations were tabulated. The clinical bottom line is that, in adult patients in ventricular fibrillation or ventricular tachycardia, manual pressure augmentation during defibrillation may reduce impedance. This might improve defibrillation success, but there is insufficient evidence to recommend this without further research.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"How long until I am seen, doc?\" Modelling paediatric emergency department waiting times to make personalised predictions.","authors":"Sarah Rahayu Hogben, Robin Marlow","doi":"10.1136/emermed-2023-213718","DOIUrl":"https://doi.org/10.1136/emermed-2023-213718","url":null,"abstract":"<p><strong>Background: </strong>ED patient wait times have been progressively increasing leading to patient dissatisfaction in ED. Managing patient expectations towards wait times in ED may be more effective at decreasing dissatisfaction than shortening actual wait times. Models for predicting wait times have been made for general EDs but not for solely paediatric departments. We aimed to create a model that could predict the personalised wait time of a child presenting to paediatric ED after triage.</p><p><strong>Methods: </strong>This was a single-centre retrospective study analysing all ED attendances to the Bristol Royal Hospital for Children between 1 January 2022 and 31 December 2022. From anonymised routinely collected administrative data, we created a multiple linear regression model to predict wait times. We developed the model by randomly assigning 80% of the data to a training set and used the remaining 20% as a validation set to assess the accuracy of our model. CIs were calculated using 500 bootstrap iterations sampled from the validation set. Understanding that patients are satisfied being seen sooner than their predicted wait time, we considered the result to be unsuccessful if their actual wait time was 30 min over their predicted wait time.</p><p><strong>Results: </strong>From 40 828 ED presentations, the median patient wait time was 65 min (IQR 34-122). Our model was able to predict wait times for 84.2% (95% CI 83.42% to 84.91%) of attendances successfully. Triage category, number of patients waiting, number of patients in the department, time of presentation, length of wait of last patient and day of week all had a significant impact on prediction of wait times (all p<0.001).</p><p><strong>Conclusion: </strong>Tailored models created using routine data can be used to give individualised predictions for wait times in paediatric ED, which could be given to patients with the aim of managing expectations and improving patient satisfaction.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical probability-adjusted (CPA) D-dimer thresholds for the exclusion of venous thromboembolism (VTE) in the emergency department.","authors":"Erin Devlin, Daniel Horner","doi":"10.1136/emermed-2025-215028","DOIUrl":"https://doi.org/10.1136/emermed-2025-215028","url":null,"abstract":"<p><p>A short review of the literature was carried out to examine the evidence supporting the use of clinical probability-adjusted (CPA) D-dimer thresholds to exclude venous thromboembolic (VTE) disease in an ED setting. Five papers were identified as suitable for inclusion using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. It is concluded that using CPA D-dimer thresholds to exclude VTE without recourse to imaging will improve the efficiency of the test, but may increase the failure rate to unacceptable levels. CPA thresholds should be used with caution on an individual basis, supported by shared decision-making.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}